Abstract:

A method of achieving outcome objectives across a clinical setting
includes receiving a diagnosis for a patient, receiving one or more
goals, each goal having a goal actual rating, a goal expected rating and
a goal expected time period, receiving one or more interventions, each
intervention having an intervention actual rating, an intervention
expected rating and an intervention expected time period, determining a
goal variance for each goal, determining an intervention variance for
each intervention, and creating a report based on the goal variance and
the intervention variance.

Claims:

1. A method of achieving outcome objectives across a clinical setting, the
method comprising:receiving a diagnosis for a patient;receiving one or
more goals, wherein each goal has a goal actual rating, a goal expected
rating and a goal expected time period;receiving one or more
interventions, wherein each intervention has an intervention actual
rating, an intervention expected rating and an intervention expected time
period;determining a goal variance for each goal;determining an
intervention variance for each intervention;creating a report based on
the goal variance and the intervention variance.

[0003]Portions of the material in this patent document are subject to
copyright protection under the copyright laws of the United States and of
other countries. The owner of the copyright rights has no objection to
the facsimile reproduction by anyone of the patent document or the patent
disclosure, as it appears in the United States Patent and Trademark
Office file or records, but otherwise reserves all copyright rights
whatsoever.

BACKGROUND

[0004]The delivery system for health care in the United States over the
past generation has evolved into a series of acute and post acute care
clinical settings. The acute care setting consists of acute hospitals,
i.e., tertiary and community hospitals. The post-acute setting consists
of rehabilitation hospitals, skilled nursing facilities, home care
organizations, as well as hospitals and private outpatient facilities.
Although these clinical settings have existed for generations, their role
in the participation of the cycle of care surrounding an acute clinical
event has been more clearly defied.

[0005]The chief architect defining the role of each setting in the last
twenty years has been Medicare. Medicare, beginning with acute settings,
changed the way they pay for care from cost reimbursement to DRG and
later for the post acute setting to PPS. DRG (Diagnosis Related Group)
and PPS (Prospective Payment System) essentially gave providers in all
settings a fixed payment (with some flexibility) for the provision of
health care appropriate to the setting. This caused significant changes
in the type and amount of care rendered in each setting with the
incentive to provide only those services necessary to produce clinical
improvement required to move the patient to the next, more appropriate,
and usually lower cost clinical setting.

[0006]The system change also affected the role of Medicare. Medicare, as
the payor, no longer focuses on medical necessities of procedures or
length of stay in a facility but now is concerned with the quality of
care and clinical outcomes. Unfortunately, through all this change, the
data to measure quality and outcomes has not evolved. The health care
system very much relies on billing data for quality and outcome measures,
which is both inaccurate and dated. The surviving clinical document at
the bedside (i.e., the SOAP note) does not answer the need for
documentation required to predict and measure attainment of goals at each
clinical setting that allow clinical and administrative decision makers
to discharge the patient to the next appropriate setting in a timely
manner. Current clinical documentation at the bedside also does not
consider the critical role the patient has in understanding and complying
with a plan of care for their disease. Lastly, as the population ages
there will be a need to care for complex multi-diagnosed geriatric
patients, this will require good retrospective data on which to base
complex prospective clinical decisions.

SUMMARY

[0007]In general, in an aspect, the invention is directed to a method of
achieving outcome objectives across a clinical setting. The invention
includes receiving a diagnosis for a patient, receiving one or more
goals, wherein each goal has a goal actual rating, a goal expected rating
and a goal expected time period, receiving one or more interventions,
wherein each intervention has an intervention actual rating, an
intervention expected rating and an intervention expected time period,
determining a goal variance for each goal, determining an intervention
variance for each intervention, and creating a report based on the goal
variance and the intervention variance.

[0008]Aspects of the invention may include one or more of the following
features. The report can comprise each goal variance exceeding a
predetermined threshold. The predetermined threshold can be zero. The
report can comprise each intervention variance exceeding a predetermined
threshold. The report can categorize the one or more goals into
disease-directed goals and patient-directed goals. The step of
determining the goal variance can comprise subtracting the goal expected
rating from the goal actual rating. The step of determining the
intervention variance can comprise subtracting the intervention expected
rating from the intervention actual rating. The method may include
receiving demographic information for the patient. The method may include
determining the goal expected rating based on prior data. The method may
include determining the goal expected time period based on prior data.
Receiving the one or more goals can comprise receiving disease management
goals, wherein each disease management goal comprises an actual disease
management severity rating and an expected disease management severity
rating. Receiving one or more goals can comprise receiving one or more
patient management goals, wherein each patient management goal comprises
an actual patient management functionality rating and an expected patient
management functionality rating. Receiving one or more interventions can
comprise receiving one or more disease management interventions, wherein
each disease management intervention comprises an actual disease
management intervention efficiency rating and an expected disease
management intervention efficiency rating. Receiving one or more
interventions can comprise receiving one or more patient management
interventions, wherein each patient management intervention comprises an
actual patient management intervention efficiency rating and an expected
patient management intervention efficiency rating.

[0009]The GIVE ("Goals, Intervention, Variances, Expectations") analysis
presents a new format for documentation and communication in health care
at the bedside. GIVE, as presented, is geared for the homecare patient
setting but can have parameters adjusted for most clinical settings. GIVE
analysis uses current medical terminology and familiar rating scales to
provide clarity in clinical terms concerning the patient's current or
actual medical status. This information is then used to predict a
patient's response to therapy and how long it will take for the patient
to reach a desired clinical response. The variance between the actual and
expected response to therapy is quantifiable. The reason for the variance
is something that the clinician must analyze as either a disease
management issue or a patient management issue and change goals or
interventions based on the analysis of concrete clinical data.

[0010]The GIVE analysis focuses on disease severity, patient
functionality, and intervention efficacy. The system is geared for a
clinical team including physician, nurse practitioner, nurse, physical
therapist, occupational therapist, speech therapist, social worker, and
most importantly, the patient. GIVE allows for clarity in the
communication among team members at any moment in time. The attention of
the clinicians is focused on those diagnoses that have a variance greater
than zero. These diagnoses have goals that have not been met and the
interventions applied to reach these goals are not completely effective.
The explanation for the variance must be meaningful and measurable so
that a possible solution can be proposed and discussed. If the variance
remains unchanged for a prolonged period of time, the responsible
clinician must defend the feasibility of a change in the variance in a
reasonable time for that particular diagnosis. If it is deemed that the
patient is unable to reach a certain predicted goal (i.e. the expectation
was too high), the expected outcome rating is changed to reflect that
decision along with the reason for the change.

BRIEF DESCRIPTION OF THE DRAWINGS

[0011]Aspects, features, benefits and advantages of the embodiments
described herein will be apparent with regard to the following
description, appended claims, and accompanying drawings where:

[0012]FIG. 1 depicts a block diagram of exemplary internal hardware that
may be used to contain or implement program instructions according to an
embodiment.

[0013]FIG. 2 discloses an overview of the GIVE analysis according to an
embodiment.

[0014]FIG. 3 depicts a detailed exemplary flowchart of the GIVE analysis
according to an embodiment.

[0015]FIG. 4 depicts an en exemplary screen displaying the patient
information according to an embodiment.

[0016]FIG. 5 discloses a chart illustrating the patient's goals and
interventions according to an embodiment.

[0017]FIG. 6 depicts an illustration of setting up a report according to
an embodiment.

DETAILED DESCRIPTION

[0018]Before the present methods, systems and materials are described, it
is to be understood that this disclosure is not limited to the particular
methodologies, systems and materials described, as these may vary. It is
also to be understood that the terminology used in the description is for
the purpose of describing the particular versions or embodiments only,
and is not intended to limit the scope. For example, as used herein and
in the appended claims, the singular forms "a," "an," and "the" include
plural references unless the context clearly dictates otherwise. In
addition, the word "comprising" as used herein is intended to mean
"including but not limited to." Unless defined otherwise, all technical
and scientific terms used herein have the same meanings as commonly
understood by one of ordinary skill in the art.

[0019]FIG. 1 depicts a block diagram of exemplary internal hardware that
may be used to contain or implement program instructions according to an
embodiment. Referring to FIG. 1, a bus 100 serves as the main information
highway interconnecting the other illustrated components of the hardware.
CPU 105 is the central processing unit of the system, performing
calculations and logic operations required to execute a program. Read
only memory (ROM) 110 and random access memory (RAM) 115 constitute
exemplary memory devices.

[0020]A disk controller 120 interfaces with one or more optional disk
drives to the system bus 100. These disk drives may include, for example,
external or internal DVD drives 125, CD ROM drives 130 or hard drives
135. As indicated previously, these various disk drives and disk
controllers are optional devices.

[0021]Program instructions may be stored in the ROM 110 and/or the RAM
115. Optionally, program instructions may be stored on a computer
readable medium such as a compact disk or a digital disk or other
recording medium, a communications signal or a carrier wave.

[0022]An optional display interface 140 may permit information from the
bus 100 to be displayed on the display 145 in audio, graphic or
alphanumeric format. Communication with external devices may occur using
various communication ports 150. An exemplary communication port 150 may
be attached to a communications network, such as the Internet or an
intranet.

[0023]In addition to the standard computer-type components, the hardware
may also include an interface 155 which allows for receipt of data from
input devices such as a keyboard 160 or other input device 165 such as a
mouse, remote control, pointer and/or joystick.

[0024]FIGS. 2-6 are diagrams providing more detail on the processes, which
the system described above, or other systems, can carry out. FIG. 2
discloses an overview of the GIVE analysis according to an embodiment.
The GIVE analysis may be used at a clinical center. A clinical center may
include, but is not limited to, a hospital or a rehabilitation center, an
outpatient facility and a nursing home. A patient at a clinical center
may have one or more diseases. Based on the disease, one or more
diagnoses may be received for each patient 205.

[0025]The goals and interventions may be divided into disease-directed and
patient-directed categories. For each diagnosis, one or more
diseases-directed goals and interventions and one or more
patient-directed goals and interventions may be received 210.

[0026]In an embodiment, rating scales may be used to document each goal
and intervention towards the lessening of acuity of the diagnoses. GIVE
rating scales may be designed to address this need and give a common
language to all clinical team members. This common language used by all
members of a clinical team may be based on the descriptive terms that
have long been used in the medical/surgical and rehabilitation fields.

[0027]Each goal and intervention may have an actual rating and an expected
rating. The rating may be on a severity, function or efficacy scale, as
explained in further detail below. The GIVE rating scales may be used in
a dynamic fashion to follow and update a clinical care plan for each
diagnosis of the patient. The standardization of the terms into a rating
scale may allow a member of the clinical team to use the scales to assign
an actual rating, an expected rating with a timeline to discuss the
variances at preset intervals. Thus, the ratings may be used to allow the
team to move efficiently and effectively toward the outcome.

[0028]The actual rating may be the rating of the patient at the current
time the patient is assessed. The expected rating may be a forecasted
rating projecting the outcome objective. The actual rating and the
expected rating may be received 215 by the GIVE system.

[0029]The GIVE system may also receive 220 an expected time period. The
expected time period may be the amount of time in which the expectation
rating will be met for each goal and each intervention. In an embodiment,
the expected time period will be the amount of time needed to reach the
expected rating from the actual rating. The expected time period may be,
but is not limited to, a set number of hours, days, weeks, or months. The
expected time period may be used to reinforce an outcome timeline with a
patient and may allow for discharge services to be planned and
implemented accordingly. As discussed below, both the expected rating and
the expected time period may be changed during the periodic review as the
clinical staff has more observations, data and interactions with the
individual patient.

[0030]In an embodiment, the expected rating and/or the expected time
period may be determined based on historical data. In an embodiment, the
expected rating and/or the expected time period may be based on what
clinical endpoint the clinical professionals have experienced
historically dealing with similar medical, surgical, or rehabilitative
diagnoses. In an embodiment, the expected rating and/or the expected time
period may be based on statistical evidence from medical literature. In
an embodiment, the expected rating and/or the expected time period may be
based on a compilation of data gathered within the individual health care
team experience with the GIVE Analysis system.

[0031]Based on the actual rating and the expected ratings, a variance may
be calculated 225 for each goal and intervention. A variance is the
difference between the actual rating and the expected outcome rating. A
variance greater than zero may represent a patient which has not yet
reached their goals.

[0032]A report may be created 230 with the variances. The chart may be
used to evaluate the effectiveness of the goals and/or interventions
within a time period in a particular setting. In an embodiment, the
report may only include variances greater than zero. The report may be
used to focus the attention of the clinicians on those diagnoses. If the
variance is greater than zero, the diagnosis has goals that have not been
met and the interventions applied to reach these goals have not been
completely effective.

[0033]In an embodiment, the clinician's explanation for the variance must
be meaningful and measurable so that a possible solution can be proposed
and discussed. If the variance remains unchanged for a prolonged period
of time, the responsible clinician must defend the feasibility of the
implementation in a reasonable time for that particular diagnosis. If it
is deemed that the patient is unable to reach a certain predicted goal
(i.e. the expectation was too high), the expected rating may be changed
to reflect that decision along with the reason so that a zero variance
may be reached.

[0034]FIG. 3 depicts a detailed exemplary flowchart of the GIVE analysis
according to an embodiment. In an embodiment, demographic information for
each patient may be received 305. In an embodiment, a patient may receive
a number or identification which is associated with the patient. FIG. 4
depicts an exemplary screen displaying the patient information according
to an embodiment. As depicted in FIG. 4, a physician may enter a
patient's name 401 and the information regarding the patient may be
retrieved.

[0035]Referring also to FIG. 3, one or more diagnoses may be received for
each patient 310. In an embodiment, the diagnoses may be received by the
GIVE system in order of importance. In an alternate embodiment, the
diagnoses may be received in any order and the GIVE system may order the
diagnoses. For example, a diagnosis which carries greater potential of
morbidity may be listed above a diagnosis which lesser potential of
morbidity.

[0036]In an embodiment, an ICD-9 code may be associated with each
diagnosis. Additionally, in an embodiment, medications and dosages may be
associated with each diagnosis. The medications and dosages may be the
medications and dosages currently taken by the patient.

[0037]In an embodiment, a severity scale may be used to rate the current
acuity of the diagnosis. An actual severity rating, an expected severity
rating, and an expected time period may be received for each diagnosis
315. Since the diagnosis is being actively treated, the rating is
expected to improve depending on the success of the treatment. The
dosages and types of medication can be altered throughout the treatment.

[0038]In an embodiment, the severity scale may be rated 0 to 4. A rating
of 0 may represent that the patient is asymptomatic and/or no treatment
is needed at this time. A rating of 1 may represent that symptoms are
well controlled with the current treatment. A rating of 2 may represent
that the symptoms are controlled with difficulty and/or continuous
monitoring is needed. A rating of 3 may represent that the symptoms are
poorly controlled and/or there is a frequent change in
treatment/medications. A rating of 4 may represent that the symptoms are
poorly controlled and there is a risk of re-hospitalization.

[0039]In an embodiment, each diagnosis has an actual severity rating and
an expected severity rating. The actual severity rating may be the rating
received for the patient at the actual time of assessment. If the patient
is at a clinical facility, the actual severity rating may be the time
when the patient is first admitted. If the patient is at home, the actual
severity rating may be the time when the patient is first assessed. Each
time a patient has a visit with one of the members of the clinical team,
a new actual severity rating may be received by the GIVE system.

[0040]An expected severity rating may be the expected rating at the
patient's completion of the goal. Additionally, an expected time period
will be received by the GIVE system. The expected time period will be the
amount of time needed to reach the expected rating from the actual
rating.

[0041]In an embodiment, using the ICD-9 code for the diagnosis, one or
more goals and/or one or more interventions may be received 320. The
goals and/or interventions may be categorized 325 as either
disease-directed or patient-directed. The goals and interventions may be
categorized based on the patient and the clinical team members' role in
the rehabilitation or treatment process. In an embodiment, the separation
of goals and interventions into the patient-directed and disease-directed
categories may allow the clinical team to reach goals with the patient
while continuing to evaluate the effect of treatment on the disease
process.

[0042]In an embodiment, the goal and intervention options within the
patient-directed or disease directed categories may be predetermined. In
an embodiment, there may be a limited amount of goal and intervention
options in order to focus on the major issues for the clinical teams. The
options may be limited to focus on issues that are important to the
clinical member or specialist involved in patient care. In an embodiment,
the GIVE system may provide the set of goals and/or intervention options
based on the diagnosis reflected in the ICD-9 code. The GIVE system may
receive the set of goals and/or intervention options chosen by the team
member.

[0043]A disease-directed category may relate to the objective evaluation
by the clinical team member as well as to the effectiveness of the
disease management intervention in producing the expected outcome. The
clinical team member may possess the expertise to conduct a physical
examination of the patient, review history and clinical tests results and
consider patient testimony. Using a severity and efficacy rating system,
a clinical professional may make an assessment on a periodic basis as to
the effectiveness of a disease-directed intervention in bringing about
the disease-directed management goal.

[0044]Referring also to FIG. 5, a chart illustrating the patient's goals
and interventions according to an embodiment is shown. In FIG. 5, the
disease is diabetes 505 which has an ICD-9 code of 250. Associated with
that diagnosis is the disease management goal 510 of stabilizing blood
glucose 515. Associated with the goals are interventions 520. A clinical
team member may use his/her expertise to determine the effectiveness of
an intervention on improving the signs and symptoms of the disease. T
here may be multiple interventions for and multiple team members involved
in several goals. Typically, as the rating of the intervention improves
(from 5-0 on the efficacy scale), the goal rating and the diagnosis
severity scale move in the same direction. This movement may ultimately
lead to discharging the patient to a lower acuity setting or to
independence.

[0045]In an embodiment, the expected intervention efficacy rating and the
expected time period may be automatically determined based on historical
data. In an embodiment, the expected intervention efficacy rating and the
expected time period may be determined based on clinical team experience.

[0046]Referring back to FIG. 3, one or more disease management goals and
associated disease management severity ratings may be received 330. The
rating scale for each disease management goal may be measured on the
severity scale discussed above. Associated with each disease management
goal may be an actual disease management severity rating and an expected
disease management severity rating. As with the actual disease severity
rating and the expected disease severity rating, an actual disease
management severity rating may be the severity of the disease management
goal at the time a patient is assessed by a team member. The expected
disease management severity rating may be the severity of the
disease-directed management goal at the time that the patient leaves.

[0047]Each disease management goal may be associated with one or more
disease management interventions. For example, the disease management
goal may be, but is not limited to infection improvement and/or healing
progression. The one or more disease management interventions may
include, but are not limited to, therapy or medication.

[0048]A disease management intervention and an associated disease
management intervention efficacy rating may be received 335. Each disease
management intervention may be measured on an efficacy scale. In an
embodiment, an efficacy scale may have ratings from 0 to 5. A rating of 0
may represent that the intervention is totally effective. A rating of 1
may represent that the intervention is moderately to maximally effective.
A rating of 2 may represent that the intervention is minimally to
moderately effective. A rating of 3 may represent that the intervention
is minimally effective. A rating of 4 may represent that the intervention
is not effective and a rating of 5 may represent that the intervention
needs to be re-evaluated.

[0049]In an embodiment, the disease management intervention efficacy
rating may be determined by a combination of both the patient and a
clinical team member. In an embodiment, the clinical team member may be a
primary care physician (PCP) and/or specialist. The patient may
communicate the signs and symptoms of the disease and whether the process
is being improved by the one or more disease management interventions. An
actual disease intervention efficacy rating may be determined at the time
of admittance. A new actual disease intervention efficacy rating may be
determined each time the patient is assessed by the team member. An
expected disease intervention efficacy rating may be the efficacy that it
is hoped that the patient will achieve.

[0050]The patient-directed category may include one or more patient
management goals and one or more patient interventions. The
patient-directed category may refer to knowledge and skill transfer from
a clinical team member to a patient and/or a patient's caregiver. The
transfer of knowledge and skill may be a major role of the clinical team.
In an embodiment, a patient normally requires teaching and re-teaching
the skills that he/she will need in the short and long-term to manage
their disease for the duration of the treatment period. In many cases,
the patient will need this knowledge and skill set for on-going self-care
of chronic diseases.

[0051]The clinical team constantly assesses the patient's ability or lack
of ability to become independent. The GIVE system may receive a patient
management goal and an associated patient management functional rating
340. The functional scale may be used to assess whether the transfer of
knowledge and skills are successful in allowing self-care/independence.
If self-care/independence is not attainable, the functional scale may
estimate in what way and for how long a patient will be involved with
professional care. In an embodiment, the ability for a patient to remain
at home is a question requiring serious evaluation and documentation
since the consequences are life-altering to the patient and their family.

[0052]In rehabilitative medicine, using the scale to judge the patient's
ability to perform tasks and/or retain knowledge about the disease
process is key to preparing the patient for self-care and reaching
independence. In the functional scale, a rating of 0 may mean that the
patient is independent. A rating of 1 may mean that the patient requires
supervision and/or is modified independent. A rating of 2 may mean that
the patient needs minimal/moderate assistance. A rating of 3 may meant
that the patient needs moderate/maximum assist. 4 may mean that the
patient needs maximum assistance and a rating of 5 may mean that the
patient is totally dependent

[0053]For example, the functional scale may be used to assess the progress
of the patient management goals relating to the knowledge and skills
gained by the patient throughout the course of therapy. Therapy usually
involves a transfer of knowledge or skills from the expert clinical team
member to a patient or caregiver in the field. Since patient involvement
is a key to success, it is important to clearly articulate to the patient
their goals and the expectation of the clinical staff. The functional
scale goes from totally dependent (5) to totally independent (0).

[0054]In FIG. 3, the GIVE system may receive a patient management
intervention and an associated patient management intervention efficiency
rating 345. The patient interventions may be rated on an efficiency scale
as discussed above with the disease interventions. In an embodiment, the
patient management intervention efficiency rating may be determined based
on the knowledge gained by the patient from the team member.

[0055]After actual and expected ratings are received for the disease
management goals, the disease management interventions, the patient
management goals and the patient management interventions, one or more
variances may be determined 350. A variance is the difference between the
actual and expected rating on a particular date and time. A diagnosis
that has a variance greater than zero has goals which have not been met
and the interventions applied to reach the goals have not been completely
effective.

[0056]Each variance may be explained, by a clinical team member, in a
meaningful and measurable way so that a possible solution can be proposed
and discussed. If the variance remains unchanged for a prolonged period
of time, the responsible clinical team member must defend the feasibility
of the implementation. If it is deemed that the patient is unable to
reach a certain predicted goal (i.e. the expectation was too high), the
expected outcome is changed to reflect that decision along with the
reason so that a zero variance may be reached.

[0057]The GIVE system may receive a patient reassessment, i.e., a new
actual rating, at a predetermined interval 355. The predetermined
interval for patient assessment may be determined by the GIVE system. In
an embodiment, the interval may be based on the severity of the rating.
In an embodiment, the interval may be determined by the variance. Each
time a patient is reassessed, a new set of actual ratings may be received
315 and a new variance may be determined 350 based on the new actual
rating. The new variance may be compared with the previous variance to
determine if the patient is reaching the expected rating.

[0058]In an embodiment, the interval of time to reassess the intervention
may be determined by the potential morbidity of the diagnosis or symptom.
For example, if the improvement in 02 sats is the goal based on
chest physical therapy and actual medication, then it is not unreasonable
to measure the effectiveness in hours rather than days, since the
deterioration can be life threatening. In another case, the effectiveness
of physical therapy on the gait improvement in a hip replacement patient
is an issue of much less morbidity and a week may be a more appropriate
time to expect the intervention to yield the desired effect.

[0059]In an embodiment, the expected outcome rating may be changed or
modified when the patient is examined. The GIVE system may receive a
modified expected rating 260.

[0060]A report may be created 265 by the GIVE system. In an embodiment,
the report may include, but is not limited to, demographic information
regarding a patient, the patient's medications with dosages, all
diagnoses with actual and expected ratings (severity rating), all disease
management goals with actual and expected ratings (severity rating), all
patient management goals with actual and expected ratings (functional
rating), and both disease and patient management interventions with
actual and expected ratings (efficacy rating).

[0061]FIG. 6 depicts an illustration of setting up a report according to
an embodiment. In FIG. 6, a report maybe generated using a report set-up
window 600 from the GIVE system. In an embodiment, a report may be
filtered by the site of a particular healthcare facility 605. In an
embodiment, a report may be filtered by a case manager or a member of the
clinical team 610. In an embodiment, the report may be filtered by the
patient.

[0062]In an embodiment, the report may provide the most recent clinical
evaluation, with the actual ratings from each assessment and the expected
rating. The report may provide the variances after each actual rating.
The report may allow the team to focus in those diagnoses, goals, and
interventions with a variance. In an embodiment, the report only lists
variances greater than zero. In an embodiment, the report may only list
variances exceeding a predetermined variance amount. These high variances
may be in a report because the actual rating may be significantly higher
than the expected rating i.e. there is a higher potential morbidity in
disease management goals or there is a significant educational need in
patient management goals.

[0063]The report may be used in a team meeting to focus clinicians on
those diagnoses that have a variance greater than zero. If the diagnosis
variance is zero, this means that every goal and intervention has been
met. If there are any remaining variances for goals and interventions
related to the diagnosis, the variance for the diagnosis should not be
zero. In an embodiment, as variances reach zero for goals and
interventions, they will not appear on future reports, allowing the team
to locus on only those unmet goals and interventions. Those goals with a
zero variance may be reevaluated at a certain interval of time to ensure
that the patient does not decompensate. If there is a variance, the
diagnosis has goals that have not been met and the interventions applied
to reach these goals have not been completely effective. The team member
may need to provide an explanation for the variance that is meaningful
and measurable so that a possible solution can be proposed and discussed.

[0064]In an embodiment, if the variance remains unchanged for a
predetermined period of time the responsible clinician must defend the
feasibility of the expected rating in a reasonable time for that
particular diagnosis. If it is deemed that the patient is unable to reach
the expected rating (i.e. the expectation was too high), the expected
rating may be changed to reflect that decision along with the reason so
that a zero variance is reached.

[0065]In an embodiment, the report may begin with the disease management
goals with the highest variance in diagnosis and proceed to those with
the lowest variance. The disease management interventions may continue to
be appropriate or will be require adjustment or a completely new
intervention.

[0066]In an embodiment, the report may then proceed to the patient
management goals with the highest variance and proceed to those with the
lowest variance. The patient management interventions may continue to be
appropriate or will be require adjustment or a completely new
intervention.

[0067]The variance may apply to the duration that is assigned to the
particular goal or intervention. The difference in time between the date
of the actual rating and the date of the expected rating is the variance
of time.

[0068]In an embodiment, the report may have a high variance category. The
high variance category may list the patients with a high variance. The
high variance may be determined by comparing a patient's variance to a
predetermined number. For example, the predetermined variance may have
been six. This means that all patients that have a cumulative diagnosis
variance of six or greater may be selected. For example, if Joe Shmoe has
three diagnoses: Diabetes with a variance of 2, Hypertension with a
variance of 2, and Abnormal Gait with a variance of 2, the total variance
would be 6 so Joe would be shown in the high variance report.

[0069]In an embodiment, all patients that have an individual diagnosis
variance of greater than zero and have not changed in three or more weeks
may be on placed in the high variance category. The high variance
category may be reviewed at team meetings until the team has designed
goals and interventions which move the patient out of this category.

[0070]In an embodiment, the report may have a medium variance category.
Patients that have a cumulative diagnosis variance of greater than 2 and
less than 6 may be selected for the medium variance category. In an
embodiment, cases may fall into two of the three categories depending on
the status of the individual patient.

[0071]In an embodiment, the report may also determine if the variance
becomes greater after a period of time. In an embodiment, if the variance
increases over time, alternative treatment may be proposed based on
historical data. In an embodiment, if the variance increases over time,
then the members of the team may determine alternate interventions. By
focusing on the unmet goals and ineffective interventions, the GIVE
analysis is designed to easily evaluate these variances. The GIVE
analysis documents the interventions that are not effective thus allowing
the clinician to reevaluate and change an ineffective intervention or
change the expectation of a goal that may be unattainable.

[0072]It will be appreciated that various of the above-disclosed and other
features and functions, or alternatives thereof, may be desirably
combined into many other different systems or applications. Also that
various presently unforeseen or unanticipated alternatives,
modifications, variations or improvements therein may be subsequently
made by those skilled in the art which are also intended to be
encompassed by the following claims.